Date: May 14, 2013

Please be advised that as of July 1, 2013, ADvantage will add Extended State Plan Skilled Nursing as a service option described as follows:

Skilled nursing services are physician ordered nursing services within the scope of the State’s Nurse Practice Act that are provided by a registered professional nurse, or licensed practical or vocational nurse under the supervision of a RN, licensed to practice in the State and are needed after the Medicaid State Plan Home Health Benefit of 36 visits per year have been exhausted. These services are intended as treatment for acute health conditions (such as wound care) reimbursable as skilled nursing care for members who do not receive Medicare benefits and who have exhausted the 36 visits available through the Medicaid Home Health Program.

For all requests for Extended State Plan Skilled Nursing, a physician’s prescription is required that specifies the primary diagnosis, frequency, expected duration, and the duties/treatments to be performed. Corresponding Goals are also required.

Waiver Service Code - G0154-TF (modifier required)

Unit of service-15 minutes

Unit Rate- $13.50

Existing ADvantage skilled nursing services (T1002 and G0154) are unaffected by the addition of the Extended Medicaid Skilled Nursing service. Per ADvantage Program Service Standards, the ADvantage skilled nurse’s primary role is to assess the Member’s health and safety, develop and implement the personal care plan, provide training and supervision to the Personal Care Assistant and/or Advanced Supportive/Restorative aide and ongoing assessment of the suitability of the care plan to meet the Member’s needs. Additional G0154 coded nursing services required for meeting the member’s chronic, long-term care needs may be included on the plan of care, such as filling insulin syringes, setting up medications, diabetic nail care, etc.

If you have any questions regarding the information provided above, please feel free to contact us via your Smarter Mail account.